The Doctor’s Note and How Life Can Change in an Instant

If you’ve completed your dissertation and any lingering requirements for graduation, the last day of your internship is quite a unique experience. It’s the culmination of five years (minimum) of graduate work. You walk into work as “Mr.” or “Ms.” and come out as “Dr.”. On my last day of internship I spent most of the afternoon finishing up paperwork, transferring patients to the soon-to-be arriving interns and saw a few patients myself for termination sessions. One client, I’ll call him Seth, was very fortunate to be successfully completing therapy for Generalized Anxiety Disorder just as I was ready to graduate and move to New York City.

Termination sessions are not always pleasurable experiences, especially if the client has formed a strong bond with the therapist. But when treatment is successful it is ideally a time to celebrate the hard work done, the loss of symptoms and the newfound growth in a person.

Seth and I had worked together for eleven months. A few years younger than me, he saw me as an older and (theoretically) wiser brother. I saw him through two promotions, one demotion, a relocation to a different part of the state, three break-ups and a cancer scare. Seth had had an active year and I felt fortunate to see him work through his hardships and develop as a man. We spent most of the final session discussing what he had accomplished, ways to prevent a return of symptoms and what he might do should he need further treatment. We also talked about our sadness at the fact that we would no longer be working together. Seth got a bit glassy-eyed but didn’t lose his composure. When the session was over we shook hands and said good-bye.

“Rob, I forgot to tell you that my boss now requires a doctor’s note for my sessions so that I’m not docked pay. Can you write one for this session?”

“Sure,” I said. “My pleasure.”

I scribbled out a quick “Please excuse Seth from work from 1-2 P.M. as he had an appointment for psychological services rendered.” I signed it “Rob Dobrenski, M.A.”

Seth read the note. “No. I need a doctor’s note. This says ‘M.A.’. Isn’t that ‘Master of Arts?'”

Therapist Rule: Tell all clients your credentials prior to initiating treatment so that they may make the most informed choice about their provider. This is especially important if you are an unlicensed practitioner.

“Right,” I said. “I had told you at our first meeting that I’m a graduate student with a Master’s Degree and that I’m completing my doctorate.”

“I don’t think you told me that.”

“It’s actually a very strict requirement by the state and all doctorate programs in the United States. I’m pretty sure I told you.”

“But my boss is such a pain in the ass. He’ll freak if I bring him a non-doctor’s note.”

“I don’t understand why that’s important. You had an appointment for therapy. And I’m not about to become a doctor in the sense he’s referring to anyway.”

“No no, he’s really into titles and credentials and stuff. He’ll give me shit if it’s not signed by a Ph.D.”

“I’m sorry, Seth. I don’t know what to tell you.” I still didn’t quite get where his boss was coming from but I truly felt bad for Seth.

Seth’s eyes started darting back and forth and you could practically see the neurons in his brain firing, problem-solving. “Wait! Isn’t today your last day?”

“Yeah.”

“So aren’t you a doctor when you punch out?”

Up until that moment it hadn’t really occurred to me that my title was going to legally change in…three hours.

“Yes, technically.”

“Great, great! What time are you done?”

“Five o’clock.”

“Okay, I’ll come back then and you’ll sign the note!”

I quickly calculated what, if any, ethical violations were at play here. “But even though I’ll have signed the note as a doctor, you’re appointment would have been with a graduate student.”

At 4:57 my classmates were at the Director of Training’s party. Drunk, counting down the seconds, as I should have been. Instead I was standing at the receptionist’s desk looking for a pen. I looked up and saw Seth’s face giddy with anticipation.

“This is the moment, Dr….I mean Rob.”

“Thanks Seth. I have your note. Let me just sign it for you.”

“Wait! Not yet. It’s 4:59. Let’s treasure the moment.”

Seth and I stood facing each other. The clock ticked in the background. When it struck five o’clock, Seth handed me a pen. “Congratulations, Doctor Dobrenski.”

I leaned down and signed my new name: Rob Dobrenski, Ph.D. It looked…great. I’m a doctor…I’M A FUCKING DOCTOR! Not the real kind, but I’m a doctor!

It’s a stretch to say that the die was cast at that point but the fact remains that my name was changed forever.

And then it hit me: he didn’t really need the note for his boss. He wanted to be there when I graduated.

“Dr. Rob,” he said. “Go to New York and help people like me. I wish you nothing but the best.”

“I…thanks, Seth. Thank you.”

“You take care of yourself,” he said with a sad smile. And then he left.

I went out that night with my classmates and celebrated, drinking more alcohol than medical science would suggest possible. I told the secretary that I was secretly in love with her. She was 74 years old with three grandchildren who were older than me. I woke up the next morning with a headache that would drive weaker (and smarter) men to suicide, got in my car, and drove to New York City. The rest is history.

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23 Responses to “The Doctor’s Note and How Life Can Change in an Instant”

“Rob, I forgot to tell you that my boss now requires a doctor’s note for my sessions so that I’m not docked pay. Can you write one for this session?”
Whaaa? First: this guy got to go to therapy on *work time*? Second: his boss sounds like an idiot. A rank idiot. It shouldn’t matter what the *credentialed* therapy provider’s degree is. The indiot’s insistence on nothing less that a PHD sounds illegal *and* quite stupid. Third: the BEST therapist I’ve ever worked with has an MSL. This therapist absolutely trumps the two PHD therapists I’ve worked with, *hands down*. I think a PHD is a fine achievement, but definitely no guarantee of superior quality therapy over therapists who do not have one.

I’m glad you waited until 5pm, no sense cheating yourself out of that moment of accomplishment. It may seem small, but I wouldn’t want anything to take away from the sacrifices and sweat put into the process.

We spent most of the final session discussing what he had accomplished, ways to prevent remission and what he might do should he need further treatment.
Ummm, why do you want to prevent remission? Don’t you want to encourage/maintain it?
Dr. Rob Note: Oops.

Dr. Rob:
That was beautiful. My icy, slightly sociopathic heart just melted upon reading the end of that one. Having grown up around therapy my entire life, it’s been really great to see the more personal side of the occupation.
My mom had a client try to off himself today and she felt bad because she couldn’t transfer money out of my trust fund (I’m in college and lucky to not have to take out loans), and the funny thing is that she kind of brushed it off (I’ve gotten phone calls crying over clients … whenever she calls me when she knows I’m in class, I always excuse myself because I know something bad happened). It was weird, like some guy who said, “fuck life,” wasn’t as important as my well-being (and I’m not starving or anything).
She’s all frantic and apologetic, and I just say whatever, just go help that guy. This entry kinda touched on that, as I read it shortly after I got off of the phone with her (I reread this when I relayed it to a friend who actually just got accepted into graduate school for psychology).
Keep up the good work, man. Reading your stuff and some others in this group is kinda my therapy, and I hope I can write for you all someday.

“My mom had a client try to off himself today and she felt bad because she couldn’t transfer money out of my trust fund…”
Is this a joke?
Hey, kid, of course your mom was more upset about You, her trust fund baby. Priorities such as you getting your $$ Definitely top the latest sad-sack client of your mom’s (who was just trying to off himself; no big deal. He’s probably pulled this sort of thing before, anyway).
“She’s all frantic and apologetic, and I just say whatever, just go help that guy.”
Wow, the Compassion you show denies your “slightly sociopathic heart” claim, for sure.
Brief aside: I appear to be the only one who does Not find DOCTOR Rob’s story heart-warming, heart-melting or endearingly heart-something-or-other. I think it sort of smacks of a certain degree of smugness over his title (although he deserves credit for all his hard work to get it). Moreover, “Seth’s” groveling need to wait for the official “Dr.” title signature…so he won’t get docked for doing therapy on work time…(o, the pain of it all)…is rather odd and even a bit nauseating.
I think DocRob is very funny and filled with insightful, but Damn. I hate this story in the very cockles of this empathy-deficient heart of mine.
(Hey, kid, I hope you finally got the dough-ray-ME).:)

Sociopathic Sally:
Holy fuck, you’re funny in so many ways. And I don’t mean “Ha Ha” funny.
First of all, let’s have fun with your “I do not find Dr. Rob’s story heartwarming … blah blah bullshit bullshit.” thing into question.
Having grown up in an environment such as the one I have, well, fuck you. That’s about all, since I’m not sure you understand English well enough to argue with your stupid ass.
OK, so … I can’t just tell you to go fuck yourself … every night … before you go to bed … because you’re so much a fucking cunt that you’re pissed off that you’re not some kind of fucking cunt writer whom nobody pays attention to because you suck on so many levels it makes me kinda sad to waste my time on this. My fingers are crying. In Pain. And it’s not carpal tunnel. Just your bitchiness.
Dr. Rob has given me some sort of therapy. Believe it or not, if you want to be a total cunt about it. I enjoy reading what he has to say. I find some sort of happiness reading, rather than killing random dumb fucks like you. Sorry, but fuck you. Here’s why, on many levels.
Shocking, I know, since I’m reading something from some random asshole on the Internet whom I don’t personally know. And this random asshole (Dr. Rob, sorry Dr. Rob, I don’t mean it) gives me some sort of hope. And reading this is my therapy. So that’s “go fuck yourself, since you’ll never find a friend besides your vibrator or left hand,” since I’m sure you probably don’t know shit besides your left hand, number one. Before I say I hope you die alone … aww, fuck it, I hope you die alone.
Oh, hell, where do I start? Oh fuck, I’ve already started.
OK.
From some cunt:
“Hey, kid, of course your mom was more upset about You, her trust fund baby. Priorities such as you getting your $$ Definitely top the latest sad-sack client of your mom’s (who was just trying to off himself; no big deal. He’s probably pulled this sort of thing before, anyway).”
Sorry I’m lucky and don’t have to pay off loans.
Fuck.
My mother was kind of um … disturbed about breaking an agreement to transfer some money out of a trust fund so I can pay my rent. So go fuck yourself. Seriously. She felt bad about transferring money that I needed so I wouldn’t get evicted, and I’m lucky enough to have a trust fund. I’m sorry you weren’t so lucky, but fuck you. That’s like being jealous over some bitch who sat next to you in high school who got the awesome football player boyfriend who is now bagging my groceries. Proud, I’m sure.
Oh, man, it sucks that I have my education paid for, and I’m not totally going to get raped by the state because something so economically fucking important is free to me. Man, I’m sorry. Kill yourself.
Guess what, cunt, it’s part of a job for her. Like clients trying to off themselves. When you’re in the field, fuck, they do that. And it’s just as fucked up and disturbing every time.
You know what? Weirdly enough, I hope all of my mother’s clients turn out fine. And I find that, for some weird fuck’s sake, that I’m almost like my mother’s therapist. She calls me after some fucked up shit like that, and I’m there for her.
Guess I’m better than you, so far.
I’m tired of giving a crap about what some random nerf-herding piece of fuck says on the internet. And I’m tired in general.
It’s been a long day.
So you know what? Eat fuck.
My e-mail. tjacobs@kent.edu.
You can have it if you’re not too much of a piece of fuck to represent yourself at this point. You’ve actually made me bored of bitching you out. Congratulations.
So I guess what I’m saying is that you don’t understand a goddamn thing, go fuck yourself, and I hope you get bone cancer.
Have a nice day, cunt. DIAF.
Love,
Me
Oh, wait, I only love me. So DIAF

Wow, T.J. how in the World did you know I am left-handed????;)
Listen, I’m sorry. I really should have shown a bit more restraint…although, considering your overly liberal use of the f and C words, well…restraint is not only My challenge, I see….anyway, just calm down, already. I mean that in a caring way, not a patronizing one. I’m sorry to wig out on your hero, Doc Rob, but if he persists in writing sentences such as this one:
“”Dr. Rob,” he said. “Go to New York and help people like me.”
Well, Borderline Betty (that’s my Real name, T.J.) is gonna have to play the badie. But, hey, it’s just my opinion. Feel free to ignore it and/or rag on me for illegal Capitalization.:D Maybe all my ranting means I did not sufficiently get attached to my mother in the suckling stage…who knows…it’s possible…
And, No Problem, you being rich! Really! I think your mom is probably the one I truly have the beef with, anyway, Not you. But, No big deal w/her, either.
Take care, Kid (I won’t be using the email you provided. I’ve lost interest, just as You have, in this whole unfortunate debacle between us). I’ve decided to put it behind me. No offense to you. And, if DocR is helping you, great! I mean that.